With Donald Trump back in the White House and vaccine sceptic and conspiracy theorist Robert F Kennedy Jr expected to take control of health policy, there are fears that some drastic changes are looming as the new regime promises to “help make American healthy again”.
Africa, too, is apprehensive, fearing former President Joe Biden’s commitment to provide millions in funding to fight mpox – and a pledge of 1m vaccine doses – might also be at risk.
Covid-19 was never seen as the central issue of the 2024 presidential campaign season, but in the first post-pandemic presidential election, it reverberated as the anti-vaccine movement ascended to its greatest political heights ever.
Even in his acceptance speech, Trump alluded to changes he expects as his administration takes shape – with help from Kennedy, he told supporters, before adding: “We’re going to let him go to it.”
The Guardian reports that although it never topped his agenda, the pandemic echoed throughout Trump’s campaign. He adopted the slogan: “Make America healthy again” from Kennedy, answered supporters’ recent questions about Covid-19 vaccine mandates in the military, and spoke about polio vaccines. Project 2025, the Heritage Foundation’s conservative playbook, repeatedly drew on anger about mask mandates.
One prominent concern from experts is the damage that could be wrought by putting a vaccine sceptic at the helm of powerful federal health agencies. Trump has not announced a specific role for Kennedy in the administration, but Kennedy said he was “promised” control over health policy.
Kennedy, who had been running as an independent candidate in the 2024 presidential election but dropped out and endorsed Trump in August, is a conspiracy theorist known for spreading unfounded claims, including the idea that HIV does not cause Aids.
“The first issue on the table is vaccines,” said Dr Michael Osterholm, the director of the Centre for Infectious Disease Research and Policy at the University of Minnesota.
Even without changing public policy, Osterholm said, if authorities with the imprimatur of the federal government speak out against vaccines, “that discourages people who might otherwise be vaccinated …which is as bad as not having a vaccine at all”.
The effects are not theoretical. As recently as last week, the CDC released a report that found fewer than one in six healthcare workers had received updated Covid-19 vaccines in the 2023-24 respiratory virus season, and fewer than half had received flu shots.
Childhood vaccinations have also dipped since the pandemic. In the US, for children born in 2020-21, the rates of children under two who had received all of their vaccinations fell as the percentage who had received none grew.
The largest declines were for children who received both flu shots (-7.8%). Vaccination hesitancy and misinformation both were cited as major reasons by researchers.
“We forget what this country was like 50 years ago – how many children died every year from polio, pertussis, measles,” said Osterholm. “We’re going to see the return of diseases we have controlled for decades and with that, many additional severe illnesses in hospitals and deaths – and that’s just from the rhetoric, not even withdrawing vaccines.”
Kennedy has already recommended another vaccine sceptic and the current Florida Surgeon-General, Dr Joseph Ladapo, as secretary of Health and Human Services (HHS), a massive federal agency that houses 13 divisions and 10 sub-agencies, including the CDC and the National Institutes of Health (NIH), the largest publicly funded biomedical and behavioural research agency in the world.
Ladapo urged Floridians not to get the Covid-19 vaccine and allowed unvaccinated children to go to to school amid a measles outbreak in the state.
“RFK Jr holds a series of false beliefs not supported by scientific evidence, and he’s always a threat to vaccines,” said Dr Paul Offit, director of the Vaccine Education Centre and a doctor at Children’s Hospital of Philadelphia. Offit added that proposals in Project 2025 may hold a comparable threat.
Currently, the CDC makes recommendations about which vaccines people should get and when, including for children; the CDC works in tandem with the Food and Drug Administration (FDA), which approves vaccines.
Project 2025, the conservative playbook written in part by Trump’s former director of the office of civil rights at HHS, proposes limiting the CDC’s ability to make policy recommendations, such as producing vaccine schedules.
“Their notion was: ‘Let the parents and doctors decide’ – the notion being that the parents and doctors are just as informed as the people sitting around making those decisions,” said Offit.
Put another way, said Osterholm: “We often say a physician who treats himself is a fool.”
Not just vaccines
But the wave of apprehension is not restricted to vaccines. As Trump’s victory was confirmed, Americans immediately began stockpiling abortion pills and hormones ahead of what is predicted to be a “reproductive apocalypse” under his presidency.
Healthcare providers are reporting unprecedented demand for reproductive and gender-affirming medications: “We’ve never seen this before,” they said.
When the election results were handed down last week, Rebecca Gomperts, founder of Aid Access, the leader supplier of abortion pills by mail in the United States, was huddled in a Paris apartment with her team of eight American physicians and 15 support staff. The group, which usually operates remotely, shipping out more than 9 000 abortion pills a month, had convened in person before the election, knowing they might have to spring into action.
They were right: as news of Trump’s victory spread, the website received more than 5 000 requests for abortion pills in under 12 hours – a surge even larger than the day after Roe v Wade fell.
The scenario repeated itself countrywide as news of Trump’s win broke, with women’s and trans health providers being inundated with requests for services their patients feared might be banned in a Trump administration. The telehealth service Wisp saw a 300% increase in requests for emergency contraception; the abortion pill finder site Plan C saw a 625% increase in traffic.
“Clearly, people are trying to plan for the reproductive apocalypse we anticipate will happen under a Trump presidency,” said Elisa Wells, co-founder of Plan C.
On the prospect of a national abortion ban, at one point Trump said women who obtain abortions illegally should be punished, and at other times, said the decision should be left up to the states. But his Supreme Court appointments paved the way for the overturning of Roe in 2022, and his appointments to other, lower courts have held up even the strictest of abortion bans in red states like Texas.
There are also multiple ways he could go after the prescribing and shipping of abortion pills, which now account for the majority of abortions in the country.
The panic didn’t just extend to abortion pills. Wisp told The Guardian it had already tripled its usual daily sales of emergency contraception by 11.30am on Wednesday.
It also saw a huge increase in orders of bulk Plan B packs, which went from about 30% of their emergency contraceptive orders earlier in the month to nearly 90% on Wednesday. New patient requests for Plan B also soared from 50% of their orders to 70%.
The telehealth site Hey Jane said requests for birth control had doubled, and Winx, a similar women’s health service, sold six times as many doses of Plan B by Wednesday afternoon as it had in the past seven days combined.
Dr Crystal Beal, meanwhile, was dealing with an influx of emails on Wednesday from trans patients concerned about their access to hormones and hormone-blocking therapy.
Beal runs a site called QueerDoc, which provides oestrogen, testosterone and hormone-blocking drugs. Trump is hostile to trans rights, vowing to punish doctors who provide gender-affirming care to minors, and Beal’s patients wanted to know how to protect themselves from a second Trump administration.
By early on Wednesday afternoon, QueerDoc had already received more messages that day than it would in a typical week.
“Some of it is ‘How can I safeguard my access to medication?’” Beal said. “Some of it is ‘Should I change [the gender on] my legal documents back so I’m safer? Should I stop taking medication so I’m safer?’”
Africa vaccine pledges
Closer to home, meanwhile, Africa’s main public health body said it was seeking assurances that Trump’s administration would provide the funding and mpox vaccines promised by his predecessor.
In September, former Biden pledged $500m and 1m vaccine doses to an mpox response plan led by the Africa Centres for Disease Control and Prevention (CDC).
While mpox cases continue to spread on the African continent, donors have been slow to translate their promises into money and vaccines needed to accelerate the response, reports Reuters.
Africa CDC Director John Kaseya said he would push the new administration to honour existing promises.
“As we start to discuss with some of the officials … we’ll continue to talk to them and to engage them to fulfil their commitment,” he said.
“If they don’t do that, the mistrust that we have today in Africa will lead to a major issue between the US and the continent.”
He added that he was available “to fly and to meet and discuss with them about what Africa needs in the health area and how we can work together”.
Reuters article – Africa health body calls on Trump to honour US vaccine pledges (Open access)
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